Here is the email I sent and response I got...

Thoughts?


**
My email:

I have been reading on a lot of the web about how many trans women are also prescribed Progesterone.

Have you done much research on this? Is this something I should be adding to the spiro and estradiol?

Thank You

"Progesterone (Pg) - This steroid hormone is a female sex hormone which, in conjunction with
estrogens, regulates the accessory organs during the menstrual cycle and it is particularly important in preparing the endometrium for the implantation of the blastocyte and in maintaining pregnancy. In non pregnant women progesterone is mainly secreted by the corpus luteum whereas in pregnancy the placenta becomes the major source. Minor sources are the adrenal cortex for both sexes and the testes for males. Current research indicates it balances agaisnt overactivity of both testosterone and estrogen, and effectively blocks 5-alpha-reductase enzymatic conversion of testosterone into DHT. Progesterone also plays a role in stimulationg Osteoblast (bond building) enzymes, lowering cholesterol levels, stimulating growth of epithelial tissue and lobule-alveolar systems in the breasts, and upregulation of the P-53 cell-division gene, thus offering an anti-carcinogenic effect against run-away cell division in hormone sensitive tumors."

http://www.hemingways.org/GIDinfo/hrt_ref.htm


**
Endocrinologist Response:

Based on the Endocrine Society guidelines we do not use progesterone replacement in the trans population (there are no patients I am aware of here who are taking it). This is largely due to the lack of evidence for improved outcomes, and more importantly because of the risk of adverse events with combined hormone therapy. Much of this data came from a large study called the Womens Health Initiative, which was actually stopped early due to increased breast cancer, pulmonary embolism, and cardiovascular disease in the female patients taking estrogen+progesterone compared to those taking estrogen alone.

XXXXX
Endocrinology Fellow

I've been trying to start Prometrium for about 6 months through the VA. I'm finally starting to get close to possibly getting it prescribed. At my last visit to my endo I told him flat out that if I couldn't get the med there I would find a way to try it regardless, he talked with the head of the department and I told her the same thing. I had also discussed what I researched including VA policy on progesterone and differences in synthetic and bio identical and their effects. The head of the endocrinology department asked me if I was ok with a full exam and told me she wanted to run labs. I also needed them to look at me going off spiro because I also take Lithium and the combo is effecting my kidney. Her plan is to assess where I'm at and then look into prescribing Progesterone with in my next visit or so. Basically I explained why I wanted to take it and my awareness of VA policies and the meds effects with both Doctors and it seems they're willing to work with me after that. In the past I had asked to take it with very weak arguments for my provider.

It's not just the VA. My doctor does not prescribe Progesterone because he's seen mixed studies on its safety.

Sorry for the stupid question but can someone explain what does "VA" mean ?

Most likely Veterans Administration.

VA - Veterans Affairs

And I have came to the same road block with this.  My Endo pretty much had the same response. 

Thank you TechGirl and Hannah-Emma for clarifying that (I am french and have a poor knowledge of american acronyms).

Quote from: Pipes on January 30, 2016, 11:25:57 PM
**
Endocrinologist Response:

Based on the Endocrine Society guidelines we do not use progesterone replacement in the trans population (there are no patients I am aware of here who are taking it). This is largely due to the lack of evidence for improved outcomes

Am J Surg Pathol. 2000 Jan;24(1):74-80.

Short-term and long-term histologic effects of castration and
estrogen treatment on breast tissue of 14 male-to-female transsexuals
in comparison with two chemically castrated men.

"(...) Hence, combined progestative antiandrogens and estrogens are
necessary for genetically male breast tissue to mimic the natural
histology of the female breast."

"(...)Hence, Orentreich and Durr9 appropriately concluded from their
theoretical studies that estrogen alone or combined with orchidectomy
may not always induce acinar formation in the male mammary gland.
These authors thought that it could not be determined whether
estrogen, orchidectomy, and progesterone together always produce
lobules and acini, but they inferred that some castrated male-to-
female transsexuals who had received estrogens and progestins for prolonged
periods have breast tissue that histologically simulates
that of the female, that is, with acinar and lobular formation.
9 Our study now shows their hypothesis in general to be correct, but
it does not take an orchidectomy for the acinar and lobular formation
to occur, and moreover, such formation seems to decrease when
progestative antiandrogen treatment is stopped after surgical
castration.

Our findings in patient F indicate that prolonged and
regular intake of proper doses of progestins and estrogens
is needed for the full development and maintenance
of the female histology."

"(...)progestative drugs are known to stimulate
the formation of acini and lobules in females.7 "

J Sex Med. 2014 May;11(5):1240-7.
Clinical review: Breast development in trans women receiving cross-sex hormones.

"Our knowledge concerning the natural history and effects of different cross-sex hormone therapies on breast development in trans women is extremely sparse and based on low quality of evidence. Current evidence does not provide evidence that progestogens enhance breast development in trans women. Neither do they prove the absence of such an effect. This prevents us from drawing any firm conclusion at this moment and demonstrates the need for further research to clarify these important clinical questions."

Journal of the Gay and Lesbian Medical Association, Vol. 4, No. 4, 2000

"The use of progesterone to augment breast development
is controversial in physicians treating MTF transsexuals."

"Although some physicians working with transgendered patients do not
prescribe progesterone, others argue feminization involve the actions of
both estrogen and progesterone (31)."

"Progesterone is important for breast development (24)."

"Micronized progesterone (Prometrium) is advantageous because it has
a more favorable side effect profile (anxiety and irritability)"

Endocrine therapy of transsexualism and potential
complications of long-term treatment.
Archives of Sexual Behavior. Date: 04-05/1998

"the addition of a progestin is indicated initially or several months following
onset of estrogen therapy which may have an additional effect on breast enhancement."

Steroids. 2004 Mar;69(3):145-59.

"The importance of the sex steroid hormones 17beta-estradiol
and progesterone for normal development of the mammary gland was
recognized several decades ago and has been unequivocally confirmed
since."

Volume 18a of Elsevier's New Comprehensive
Biochemistry, Titled 'Hormones and Their Actions, Part I', Published 1988.

"Progesterone also acts synergistically with estrogen in the normal
development of the breast.  Estrogen stimulates cell mitosis and growth
of the ductal system, while lobular development and differentiation is
dependent on progesterone.  When estrogen is administered in the absence
of progesterone, the tubular system proliferates and the ducts dilate
resulting in the formation of cysts and fibroses.  These changes are
comparable to those observed in fibrocystic disease and are suppressed
by progestins, so that normal breast development requires that estrogen
and progesterone be administered together.[2-4]"

Climacteric. 2012 Apr;15 Suppl 1:11-7.

"Micronized progesterone has also been shown not to increase the risk of venous thromboembolism and further reduced the incidence of new-onset diabetes when combined with transdermal estrogen. Micronized progesterone has a neutral effect on the vasculature, including a neutral or beneficial effect on blood pressure."

Menopause. 2014 Jan 6.

"Results of this small, double-blind, placebo-controlled, cross-over study showed that the use of orally administered natural progesterone caused a significant reduction in BP in individuals with mild to moderate HTN who were not using any other antihypertensive medications."

Psychoneuroendocrinology. 2008 Sep;33( 8 ):1124-31.

"In summary progesterone demonstrated a distinct sleep promoting effect by reduction of time of wake without impairing cognitive functions during daytime. As possible mechanisms of progesterone a GABA-agonistic effect and the regulation of gene expression via the progesterone receptor are discussed. Progesterone might be useful in the treatment of sleep disturbances of postmenopausal women."

J Womens Health Gend Based Med. 2000 May;9(4):381-7

"When compared with the MPA-containing
regimen, women using micronized progesterone-containing HRT
experienced significant improvement in vasomotor symptoms, somatic
complaints, and anxiety and depressive symptoms."

Maturitas. 2015 Mar 9.

"In a cross-sectional study of 176 women who had previously switched from HT containing MPA to HT containing micronized progesterone, 71% had switched because of the better side effect profile, 35% because they believed the long-term risks would be fewer, and 23% because of intolerance to MPA [21]. When evaluated at 1 to 6 months after switching, the women experienced significantly better quality of life, including less depression and anxiety, than with MPA (both P < 0.001) [21]. Patient satisfaction questionnaires also indicated that women preferred micronized progesterone over their previous regimen for better symptom control and fewer adverse effects (P < 0.001) [21]. In the study by Ryan and Rosner of CEE with either progesterone or MPA, results on the Women's Health Questionnaire showed a significant group-by-visit interaction indicating better quality of life in the progesterone group in the cognitive difficulties domain (P = 0.015) [19]."

"Sleep was significantly improved after 6 months of CEE plus micronized progesterone but not with CEE plus MPA in a randomized study of 21 postmenopausal women tested in a sleep laboratory [22]. Specifically, the progesterone group (but not MPA) had significant improvements in sleep efficiency due to decreases in time spent awake"

"Progesterone stimulated nitric oxide synthesis and inhibited adhesion of platelets to endothelial cells in rat endothelial cell cultures"

Geburtshilfe Frauenheilkd. 1991 Apr;51(4):257-61.

"Because of the influence of estrane on lipids, one often advises against a replacement therapy with progestogens in hysterectomised women. With increasing knowledge of encountered extragenital functions of sexual steroids, the latter is questionable, if natural progesterone is given, which is (said to be) lipid-neutral, performing the function of the progestogens, which is quite more than reproduction only, more efficiently than estrane or gonane. Due to the competitive blocking of aldosterone the effect of progesterone is sodium-diuretic and diuretic, being as important as the therapy of climacteric complaints, as well as the consequence, which is the result of the physiological connection between progesterone and encephalics. Moreover, the effect of the progestogens is to tonicise the vascular system and is linked to a number of intestinal hormones in order to adjust their function. Therefore, progesterone seems to perform a great variety of extragenital functions. Menopausal women should not be deprived of the benefits of these functions within the framework of a replacement therapy."

Quoteand more importantly because of the risk of adverse events with combined hormone therapy. Much of this data came from a large study called the Womens Health Initiative, which was actually stopped early due to increased breast cancer, pulmonary embolism, and cardiovascular disease in the female patients taking estrogen+progesterone compared to those taking estrogen alone.

Your doctor ignores the differences between the progestogen used in this study, medroxyprogesterone acetate (MPA) and bio-identical micronized progesterone which was not used in this study.

Climacteric. 2013 Aug;16 Suppl 1:69-78.

"none of the recent statements addressed the
difference between MPA and progesterone, even though the
differences in action between the two molecules have been
demonstrated in receptor interaction and transactivation 1,16
and in vivo , in vessels 79 , brain 80 , and heart 81 . It would be
unfortunate if this confusion between the molecules deprives
menopausal women of the well-known effects and benefits of
progesterone."

Maturitas 46S1 (2003) S7–S16

"Basically all progestins do have only one effect in common, the progestogenic effect on the estrogen-primed endometrium of the rabbit, but there are large differences between progestins in the multitude of other biological effects elicited."

Climacteric. 2012 Apr;15 Suppl 1:3-10.

"Unlike some progestogens, progesterone is also not associated with an increased risk of VTE, or with an increased risk of breast cancer."

Int J Cancer. 2005 Apr 10;114(3):448-54.

"Our study shows an increased risk of breast cancer associated
with HRT use. It indicates that the association between HRT use
and breast cancer risk most likely varies according to the type of
progestogen used. There was no or little increase in risk with
estrogens used alone or combined with micronized progesterone,
at least when used for short periods. The increase in risk reached
significance when estrogens were combined with synthetic progestins
and was significantly greater than when combined with
micronized progesterone."

J Steroid Biochem Mol Biol. 2005 Jul;96(2):95-108.

"Controlled studies and most observational studies published over
the last 5 years suggest that the addition of synthetic progestins
to estrogen in hormone replacement therapy (HRT), particularly in
continuous-combined regimen, increases the breast cancer (BC) risk
compared to estrogen alone. By contrast, a recent study suggests
that the addition of natural progesterone in cyclic regimens does
not affect BC risk. This finding is consistent with in vivo data
suggesting that progesterone does not have a detrimental effect on
breast tissue."

Maturitas. 2011 Dec;70(4):354-60.

"With respect to the different pharmacological classes of progestogens, there is evidence for a deleterious effect of medroxyprogesterone acetate on VTE risk. In addition, observational studies showed that norpregnane derivatives were significantly associated with an increased VTE risk whereas micronized progesterone could be safe with respect to thrombotic risk."

Clin Ther. 1999 Jan;21(1):41-60; discussion 1-2.

"The results of published clinical studies show minimal or no changes in lipid profile, blood pressure, or carbohydrate metabolism during treatment with oral micronized progesterone.28 This safety profile contrasts with the reported negative effects of some synthetic progestins, including adverse effects on lipid metabolism and glucose tolerance. Several studies, including the 3-year prospective PEP1 study, 4, 28 have shown that oral micronized progesterone significantly improves metabolic tolerance compared with such progestins as MPA.52,54,58"

"Only minor adverse events have been reported in association with oral micronized progesterone therapy in clinical trials. Dizziness and sleepiness are the primary adverse reactions reported.33 However, these side effects can be suppressed by administering micronized progesterone once daily at bedtime. 29 Oral micronized progesterone is therefore an effective and well-tolerated form of progestogen replacement in premenopausal and postmenopausal women."

Experimental and Clinical Psychopharmacology 2007, Vol. 15, No. 5, 427–444

"It is important to note that although progesterone and synthetic progestins are used for similar purposes, these may not exert similar modulatory effects on target organs, and each progestin molecule may have specific effects on neuroendocrine action (Bernardi et al., 2006). For example, a commonly used progestin, MPA, was shown to induce more negative somatic effects"

"MPA and natural progesterone also were found to differ with respect to molecular signaling in human endothelial cells, suggesting that there may be differential cardiovascular effects"

J Hypertens. 2003 Jun;21(6):1145-9.

"We conclude that progesterone given without oestrogen does not adversely affect vascular function in postmenopausal women"

PLoS One. 2014 Jan 21;9(1)

"Results indicate that progesterone has short-term cardiovascular safety. Endothelial function, weight, bloodpressure, waist circumference, inflammation and coagulation were unchanged as were lipids except for HDL-C. The statistically significant decrease in HDL-C levels was not clinically important (based on lack of Cardiovascular Risk Profile change)."

Climacteric. 2013 Aug;16 Suppl 1:69-78.

"Natural progesterone and some of its derivatives, as
well as the non-ethinylated drospirenone and dienogest, do
not exert any androgenic effect and have no negative effect
on the lipids or on the endothelial cells 1,70 ."

"it appears that transdermal
estradiol alone or combined with natural progesterone
does not increase thrombotic risk."

"In experiments conducted in ovariectomized female monkeys
fed a highly atherogenic diet, estrogens preserved normal
endothelial-dependent dilator responses of coronary arteries
to acetylcholine, and progesterone did not alter this
cardioprotective mechanism. While MPA diminished the
endothelium-dependent vasodilation 68"

"Estradiol has been shown to trigger the expression of the
endothelial nitric oxide synthase (eNOS) gene and increase the
release of nitric oxide, causing relaxation of the vascular
smooth muscle cells."

"Progesterone or drospirenone did not interfere with the induction or activation
of eNOS by estradiol, while MPA did."

Hum Reprod. 1999 Mar;14(3):606-10.

"Natural progesterone is devoid of any androgenic activity that might compromise lipoprotein metabolism or induce teratogenicity. Moreover, it probably has a direct beneficial effect on blood vessels."

Lipids Health Dis. 2012 Oct 9;11:133.

"Cyclic, short term exposure to vaginal micronized progesterone did not alter the metabolic and cardiovascular effects of non-oral E2 in early, apparently healthy, postmenopausal women."

Menopause. 2010 Nov-Dec;17(6):1122-7.

"recent data have shown that norpregnane derivatives but not micronized progesterone increase venous thromboembolism risk among transdermal estrogens users."

"there was no significant change in APC sensitivity among women who used transdermal estrogens combined with micronized progesterone compared with nonusers."

Gynecol Endocrinol. 1993 Jun;7(2):111-4.

"Levels of lipoprotein A and liver enzymes did not change. It is concluded that micronized natural progesterone is an attractive means of progesterone supplementation in postmenopausal hormone replacement therapy without any liver-related side-effects."

Gynecol Endocrinol. 1996 Feb;10(1):41-7.
Clinical evaluation of near-continuous oral micronized progesterone therapy in estrogenized postmenopausal women.

"No significant changes were observed in blood glucose or liver enzymes."

Contraception. 1987 Oct;36(4):373-402.
Oral micronized progesterone. Bioavailability pharmacokinetics, pharmacological and therapeutic implications--a review.

"No side effects have been reported as far as lipids profile, coagulation factors and blood pressure are concerned. Therefore oral micronized progesterone appears suitable for hormonal replacement therapy in various areas"

http://www.merck.ca/assets/en/pdf/products/Prometrium-PM_E.pdf

"OVERDOSAGE
Symptoms
The toxicity of progesterone is very low."

Experimental and Clinical Psychopharmacology
2007, Vol. 15, No. 5, 427–444
Progesterone: Review of Safety for Clinical Studies

"Progesterone has been shown to be safe and effective for many clinical applications. The therapeutic effects of progesterone and its neuroactive metabolites reflect interactions with serotonin, dopamine, Nmethyl- D-aspartate, beta-endorphin, and sigma receptors (Pluchino et al., 2006; Schumacher et al., 2007)."

Steroids. 2003 Nov;68(10-13):831-6.

"Particularly, the Postmenopausal Estrogen/Progestin Intervention (PEPI) trial clearly showed the different impact of sequential micronized progesterone or medroxyprogesterone acetate (MPA) on estrogen therapy
(ET) with CEE. Indeed, while all women had increases in HDL-C and reductions in LDL-C while on estrogens, the addition of MPA was associated with a partial reversal of the positive effect on HDL-C (not on LDL-C), that was not obtained with micronized progesterone [5]."

"Indeed, by using Cynomolgus monkeys, Adams' group in North Carolina has been able to show consistently that 17β-estradiol modulates coronary arteries dilatation in estrogen-deprived animals [17]. Co-administration of natural progesterone did not alter the effect of estrogen. However, in the same model, the addition of cyclic or continuous MPA inhibited the vasodilatory effect of estrogen responses by 50% [18]. These data have been confirmed by other groups, showing that progesterone plus estradiol protects, but MPA plus estradiol does not, against coronary artery vasospasm[19], thus highlighting the difference between natural progesterone and MPA."

"Recent work looking at the additional effects of natural progesterone or MPA on coronary blood flow and myocardial ischemia in postmenopausal women shows that progesterone has synergistic vasodilatory effects when added to estrogens [26]. In contrast, MPA does not share this action, therefore indicating that, on this particular target, all progestins are not the same [26]."

J Am Coll Cardiol. 2000 Dec;36(7):2154-9.

"Combination estrogen/transvaginal progesterone gel increases exercise time to myocardial ischemia, as compared with estrogen/MPA. These results imply that the choice of progestin in women at higher cardiovascular risk requires careful consideration."

Drugs Aging 2004; 21 (13): 865-883 

"In monkeys, neither natural progesterone nor nomegestrol
acetate inhibits the beneficial effect of estrogen on the coronary artery dilator response. However, when medroxyprogesterone acetate was combined with estrogen, the positive response was inhibited by 50%.[69,70]"

Trends in Endocrinology & Metabolism
Volume 11, Issue 2, 1 March 2000, Pages 69–71

"Curiously, addition of the synthetic progestin, medroxyprogesterone, blocked the modulating effects of oestrogen on serotonin activity, while natural progesterone did not."

Just browsing through forums, you will also come across many transgendered women (including myself) noticing positive improvements in their feminization and health on bio-identical progesterone so IT IS prescribed to us and some women report positive effects. These, of course, are anecdotal.

You should perhaps see a doctor who is more informed on the subject matter or show them these papers, explaining the differences. I hope your doctor will be humble and open enough to see that he was mistaken.

Thank you KayXo for this impressive list of references. It might be very useful for discussing possible progesterone prescription with one's endocrinologist.

This is why I believe it is so important to inform ourselves about the subject matter, read studies, take the time to verify what doctors assert because they may be mistaken and we are the ones who pay the price in the end. Doctors just don't have the time or sadly, don't care enough so we must take it upon ourselves to become more knowledgeable.

More benefits of progesterone...

Growth Horm IGF Res. 2004 Jun;14 Suppl A:S18-33.

"Local synthesis of PROG in the brain and the neuroprotective and promyelinating effects of this neurosteroid offer interesting therapeutic possibilities for the prevention and treatment of neurodegenerative diseases, for accelerating regenerative processes and for preserving cognitive functions during aging."

Horm Behav. 2013 Feb; 63(2): 284–290.

"Here, we review the evidence that supports the neuroprotective effects of progesterone and discuss the various mechanisms that are thought to mediate these protective effects. We also discuss the receptor pharmacology of progesterone's neuroprotective effects and present a conceptual model of progesterone action that supports the complementary effects of membrane-associated and classical intracellular progesterone receptors. In addition, we discuss fundamental differences in the neurobiology of progesterone and the clinically used, synthetic progestin, medroxyprogesterone acetate that may offer an explanation for the negative findings of the combined estrogen/progestin arm of the Women's Health Initiative-Memory Study (WHIMS) and suggest that the type of progestin used may dictate the outcome of either pre-clinical or clinical studies that addresses brain function."

And...

Climacteric. 2013 Aug;16 Suppl 1:69-78.

"There has been considerable controversy regarding the use of
HRT since the Women ' s Health Initiative (WHI) Study was
published in 2002 63 . This controversy is due, in part, to the
confusion between progesterone and progestins, and the
incorrect belief that results related to MPA could be extrapolated
to progesterone and all other progestins. Stanczyk and colleagues 1
examined whether there is any reliable evidence to support the view
for a general, uniform effect of progestins. The authors showed distinct
differences between the progestins and progesterone, confirming the
absence of a class effect 1 ."

"The French E3N cohort study found that the association
of estrogen – progestin combinations with breast cancer risk
varied signifi cantly according to the type of progestin: the
relative risk was 1.00 (95% CI 0.83 – 1.22) for estrogen –
progesterone, 1.16 (95% CI 0.94 – 1.43) for estrogen –
dydrogesterone, and 1.69 (95% CI 1.50 – 1.91) for estrogen
combined with other progestins 73 . A subsequent study has
shown that the increased risk of breast cancer observed with
combinations other than estrogen – progesterone and estrogen
– dydrogesterone seems to apply preferentially to ER _
carcinomas, especially those ER _ /PR _ , and to affect both
ductal and lobular carcinomas 74 ."

Arch Gynecol Obstet. 2014 Aug;290(2):207-9.

"Compared to never MHT use, current use of EPT containing a synthetic progestogen for 4 or more years was associated with a significantly increased BC risk (adjusted OR 2.07; 95 % CI 1.26–3.39), but EPT containing micronized progesterone was not (adjusted OR 0.79; 95 % CI 0.37–1.71)."

"The authors concluded that: (1) ET and EPT containing natural progesterone did not increase BC risk  whereas, (2) BC risk was increased in users of tibolone or EPT containing a synthetic progestogen, respectively"

From full text

"Compared with MHT never use, BC risk was increased with MHT containing "other" progestogens (adjusted RR 1.69; 95 % CI 1.50–1.91) but not with those containing progesterone (adjusted RR 1.00; 95 % CI 0.83–1.22) or dydrogesterone (adjusted RR 1.16; 95 % CI 0.94–1.43), respectively [9]."

"All these findings taken together suggest a more favourable effect for micronized progesterone and dydrogesterone on postmenopausal mammary gland."

Breast Cancer Res Treat. 2014 Jun;145(2):535-43.

"Among short-term users, only those currently using estrogens associated with a progestagen other than progesterone/dydrogesterone had a significantly elevated breast cancer risk (HR 1.70, 95 % CI 1.50-1.91, compared with never users)."

Climacteric. 2003 Dec;6(4):293-301.

"In both peripheral and cerebral vasculature,
synthetic progestins caused endothelial disruption, accumulation of
monocytes in the vessel wall, platelet activation and clot
formation, which are early events in atherosclerosis, inflammation
and thrombosis. Natural progesterone or estrogens did not show such
toxicity."

PLoS One. 2013 Nov 1;8(11)
Risk of breast cancer by type of menopausal hormone therapy: a case-control study among post-menopausal women in France.

"We conducted a population-based case-control study in France in 1555 menopausal women (739 cases and 816 controls). Detailed information on MHT use was obtained during in-person interviews. Odds ratios and 95% confidence interval adjusted for breast cancer risk factors were calculated."

"We found that breast cancer risk differed by type of progestagen among current users of EP therapies. No increased risk was apparent among EP therapy users treated with natural micronized progesterone."

"Formulation of EP therapies containing natural progesterone, frequently prescribed in France, was not associated with increased risk of breast cancer "

Climacteric. 2013 Aug;16 Suppl 1:44-53.

"Natural, 'body-identical' progesterone, devoid of any androgenic as well as glucocorticoid activities but being slightly hypotensive due to its antimineralocorticoid activity, appears to be the optimal progestogen in terms of cardiovascular effects, blood pressure, VTE, probably stroke and even breast cancer (contrary to synthetic progestogens and particularly MPA"

Breast Cancer Res Treat. 2008 Jan;107(1):103-11.

"The association of estrogen-progestagen combinations with breast cancer risk varied significantly according to the type of progestagen: the relative risk was 1.00 (0.83-1.22) for estrogen-progesterone, 1.16 (0.94-1.43) for estrogen-dydrogesterone, and 1.69 (1.50-1.91) for estrogen combined with other progestagens."

"This study found no evidence of an association with risk according to the route of estrogen administration (oral or transdermal/percutaneous). These findings suggest that the choice of the progestagen component in combined HRT is of importance regarding breast cancer risk; it could be preferable to use progesterone or dydrogesterone."

Also this...on cancer risk in transsexual women

Journal of Clinical & Translational Endocrinology 2 (2015) 55-60

"Although studies are small, overall cancer incidence in transgender men and transgender women to-date has not been found to be different than their respective male and female controls [5]. There are no reports of change in breast cancer specific risk among transgender individuals on estrogen compared to secular trends of male breast cancer incidence. Rates are lower relative to secular trends of female breast cancer rates."

"Additionally, there are ten case reports of breast cancer development among MTF individuals on estrogen since 1968"

J Sex Med.2013Dec;10(12):3129-34.
Breast cancer development in transsexual subjects receiving cross-sex hormone treatment.

"We researched the occurrence of breast cancer among transsexual persons 18-80 years with an exposure to cross-sex hormones between 5 to >30 years. Our study included 2,307 male-to-female (MtF) transsexual persons undergoing androgen deprivation and estrogen administration (52,370 person-years of exposure)"

"Among MtF individuals one case was encountered, as well as a probable but not proven second case."

"The number of people studied and duration of hormone exposure are limited but it would appear that cross-sex hormone administration does not increase the risk of breast cancer development, in either MtF or FtM transsexual individuals. Breast carcinoma incidences in both groups are comparable to male breast cancers. Cross-sex hormone treatment of transsexual subjects does not seem to be associated with an increased risk of malignant breast development."

So, despite decades of prescribing sometimes very aggressive doses of estrogen WITH high dose progestogens (cyproterone acetate, medroxyprogesterone acetate) to tens of thousands of transsexual women (at least), breast cancer is VERY low in this population, equal to that present in men not on HRT.

The incidence of cancer is just not the same from one population to another and this is something that also needs consideration.

My doctor refused to prescribe progesterone as well. If I lived in a more populated area I'd try and find a different Doctor. But seeing I live in the middle of nowhere I am fortunate to have a doc willing to prescribe estrogen and Spiro. I'll take what I can get.


Sent from my iPhone using Tapatalk

Gather all the info provided, read it, understand it, present it to your doctor. I actually just finished writing a document on progesterone, summarizing risks, benefits, breast effects, effects on transsexual women, cancer risks in transsexual women with ample studies (& anecdotal evidence) to support.

Hopefully, your doctor will read it and change his/her opinion. Be persistent, don't be emotional.

Quote from: KayXo on January 31, 2016, 09:06:38 PM
Gather all the info provided, read it, understand it, present it to your doctor. I actually just finished writing a document on progesterone, summarizing risks, benefits, breast effects, effects on transsexual women, cancer risks in transsexual women with ample studies (& anecdotal evidence) to support.

Kay, would you share your document you are referring to ?

I can send you the document privately.

Why would you even want Progesterone? E and Spiro should be sufficient. People wanting more pills seem to want faster/better results and disregard their personal well-being.
There is no such thing as RUSHING transition. You'll RUSH into sickness or worse.

I use the VA and I will never even mention Progesterone to my Endo. I'm not Running, I'm Walking.

Sorry if i sound a little harsh. I care about all of us and I don't want to see anyone hurt themselves. 

Quote from: Jessika on February 01, 2016, 10:06:44 AM
Why would you even want Progesterone?

Ciswomen produce significant amounts of progesterone during the second part of the cycle and during pregnancy. It helps to round out breasts, with nipples and areola development and with inner lobulo-alveolar structures. It can also counter water retention sometimes seen with estrogen (but Spiro does this as well), help overcome dry skin/hair, brittle nails due to estrogen's sebum suppressing effect (and low T), improve fat distribution (glutes, hips, breasts), have an anxiolytic/anti-depressant effect if needed, improve sleep, improve memory, stimulate female-type libido, etc. It can also reduce blood pressure, like Spiro.

QuoteE and Spiro should be sufficient.

The addition of progesterone can help or NOT. It depends.

QuotePeople wanting more pills seem to want faster/better results and disregard their personal well-being.
There is no such thing as RUSHING transition. You'll RUSH into sickness or worse.

It's not about wanting more pills but wanting a hormone that is strongly present in females that may have benefits on feminization and well-being. Progesterone is quite safe (toxicity is very low), studies have confirmed it. Besides, huge amounts of it are produced during pregnancy, to which not the only mother but the fetus are exposed for several months. Let's not get carried away.

QuoteI care about all of us and I don't want to see anyone hurt themselves. 

Much appreciated but like I said, progesterone is unlikely to cause harm and is actually safer than Spironolactone, a molecule not even native to our bodies which can mess up electrolytes, reduce blood pressure too much and cause cardiac arrest and other negative symptoms if the necessary precautions are not taken and if not supervised by doctors.

Thank you everyone, especially KayXo.

I sent my endo a follow up email requesting clarification and quoted a lot of what KayXo posted.

I will post back when I get a response.

Endocrine Reviews, April 2013, 34(2):171–208

"To avoid confusion in light of current practices, the North American Menopause Society has recommended that the term progestogen should be used when referring to progesterone and synthetic progestogens collectively, whereas the name progestin is specific only to synthetic progestogens (4)."

Here they consider progesterone, natural and all other progestogens (or progestins) synthetic when really they are all produced in the lab, hence synthetic. Instead, they should say progesterone is BIO-IDENTICAL (identical to what the body produces) while all others aren't.

A quick lesson in endocrinology. Some doctors that treat us are unaware of these differences and how these impact us, our bodies, our health, our psyche. All progestogens are molecularly different and even a small modification of the molecule can lead to significant changes in how it affects the body.

Here is the reply I just got from my VA endo.

"You are correct to point out that the Womens Health Initiative studied medroxyprogesterone, not micronized progesterone. However there have not been any large scale studies specifically with progesterone so the best we can say is the effect on things like breast cancer and blood clots is unclear. If we considered adding progesterone, I would have to document a discussion between us regarding the potential risks of the medication. If you want to pursue this further can you schedule an appointment to come in, probably in 2 months or so?

Thanks for sharing the journal articles, those are useful."

   Hi, I go to the Miami and Fort Lauderdale VA centers.I believe ,because my civilian  Obgyn prescribed prometrium for me they also were able get it added to the VA available medications when I asked . Some of the other girls I know are now also on it through the VA.
  The other question everyone asks is ,how beneficial is it? I can't really say, I started taking it about 8 months in have only stopped once and that was when I had GCS about 2 months ago.
i guess the funny part of everything was I did not miss any of the meds, still felt the same without them.  The other part of that is my t was almost non existent and my e sits around 60 + - and has never been over 125. Yes ,even at 66 with no work done other than GCS I do pass very well ,there are several members here can attest to that .I was just lucky.